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Journal of Autoimmunity Dec 2017A bottleneck for immunotherapy of cancer is the immunosuppressive microenvironment in which the tumor cells proliferate. Cancers harness the immune regulatory mechanism... (Review)
Review
A bottleneck for immunotherapy of cancer is the immunosuppressive microenvironment in which the tumor cells proliferate. Cancers harness the immune regulatory mechanism that prevents autoimmunity from evading immunosurveillance and promoting immune destruction. Regulatory T cells, myeloid suppressor cells, inhibitory cytokines and immune checkpoint receptors are the major components of the immune system acting in concert with cancer cells and causing the subversion of anti-tumor immunity. This redundant immunosuppressive network poses an impediment to efficacious immunotherapy by facilitating tumor progression. Tumor-associated myeloid cells comprise heterogeneous populations acting systemically (myeloid-derived suppressor cells/MDSCs) and/or locally in the tumor microenvironment (MDSCs and tumor-associated macrophages/TAMs). Both populations promote cancer cell proliferation and survival, angiogenesis and lymphangiogenesis and elicit immunosuppression through different pathways, including the expression of immunosuppressive cytokines and checkpoint inhibitors. Several evidences have demonstrated that myeloid cells can express different functional programs in response to different microenvironmental signals, a property defined as functional plasticity. The opposed extremes of this functional flexibility are generally represented by the classical macrophage activation, which identifies inflammatory and cytotoxic M1 polarized macrophages, and the alternative state of macrophage activation, which identifies M2 polarized anti-inflammatory and immunosuppressive macrophages. Functional skewing of myeloid cells occurs in vivo under physiological and pathological conditions, including cancer and autoimmunity. Here we discuss how myeloid suppressor cells can on one hand support tumor growth and, on the other, limit autoimmune responses, indicating that their therapeutic reprogramming can generate opportunities in relieving immunosuppression in the tumor microenvironment or reinstating tolerance in autoimmune conditions.
Topics: Animals; Autoimmunity; Cell Proliferation; Humans; Immunosuppression Therapy; Immunotherapy; Myeloid Cells; Myeloid-Derived Suppressor Cells; Neoplasms
PubMed: 28728794
DOI: 10.1016/j.jaut.2017.07.010 -
Current Opinion in Critical Care Apr 2022Intensive care management of patients who have undergone organ transplantation of liver, small bowel, pancreas, and/or kidney requires a basic knowledge of... (Review)
Review
PURPOSE OF REVIEW
Intensive care management of patients who have undergone organ transplantation of liver, small bowel, pancreas, and/or kidney requires a basic knowledge of immunosuppression principles and the management of immunosuppressive medications. This review highlights the core principles of immunosuppression management in abdominal organ transplantation with a focus on complications arising from immunosuppressive drugs, both in the immediate postoperative period and in long-term usage.
RECENT FINDINGS
The general principles of management of immunosuppression in the abdominal organ transplant population have remained largely unchanged. Improvements in drug monitoring coupled with improvements in knowledge of pathways involved in allograft rejection have further refined immunosuppressive therapy. Infectious and central nervous system complications remain prevalent and are common complications of immunosuppressive drug therapy.
SUMMARY
For the intensive care professional who cares for abdominal organ transplant recipients, a foundational knowledge of the core principles of immunosuppression management is essential. In addition, an understanding of the common immunosuppressive drug regimens and the complications associated with these regimens is required for optimal management, risk assessment, and outcomes.
Topics: Abdomen; Graft Rejection; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney; Organ Transplantation
PubMed: 35142726
DOI: 10.1097/MCC.0000000000000927 -
Thoracic Surgery Clinics Feb 2018Lung transplantation remains a viable option for patients with endstage pulmonary disease. Despite removing the affected organ and replacing both lungs, the risk of lung... (Review)
Review
Lung transplantation remains a viable option for patients with endstage pulmonary disease. Despite removing the affected organ and replacing both lungs, the risk of lung malignancies still exists. Regardless of the mode of entry, lung cancer affects the prognosis in these patients and diligence is required.
Topics: Humans; Immunosuppression Therapy; Incidental Findings; Lung Neoplasms; Lung Transplantation; Postoperative Complications; Prognosis
PubMed: 29150033
DOI: 10.1016/j.thorsurg.2017.09.003 -
Critical Care Nursing Quarterly 2016Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold... (Review)
Review
Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.
Topics: Critical Care Nursing; Graft Rejection; Heart Transplantation; Humans; Immunosuppression Therapy; Intensive Care Units; Monitoring, Physiologic; Postoperative Care; Postoperative Complications
PubMed: 27254638
DOI: 10.1097/CNQ.0000000000000116 -
Transplant Infectious Disease : An... Aug 2021"Outcomes of COVID-19 in solid organ transplant (SOT) recipients: a matched cohort study" by Pereira et al found similar 28 day mortality among hospitalized SOT...
"Outcomes of COVID-19 in solid organ transplant (SOT) recipients: a matched cohort study" by Pereira et al found similar 28 day mortality among hospitalized SOT recipients and comorbidity matched controls, shedding light on the relationship between immunosuppression and Covid-19 outcomes.
Topics: COVID-19; Cohort Studies; Humans; Immunosuppression Therapy; Organ Transplantation; SARS-CoV-2; Transplant Recipients
PubMed: 34325492
DOI: 10.1111/tid.13650 -
Transplant Infectious Disease : An... Dec 2022
Topics: Humans; Organ Transplantation; Sepsis; Immunosuppression Therapy; Bacteremia; Gram-Negative Bacterial Infections; Gram-Negative Bacteria; Retrospective Studies
PubMed: 36411541
DOI: 10.1111/tid.13966 -
Clinics in Liver Disease May 2017Liver transplantation outcomes have significantly improved over the past few decades owing largely to the introduction of effective immunosuppression medications.... (Review)
Review
Liver transplantation outcomes have significantly improved over the past few decades owing largely to the introduction of effective immunosuppression medications. Further comprehension of the unique immune microenvironment of the liver has led to the development of newer molecular targeted therapeutics. Understanding the mechanism of action and adverse effect profiles of these medications is crucial for appropriate management of posttransplant patients. In this review, the author describes the immunologic response elicited by liver transplantation, chronicles the various immunosuppressant drug classes, discusses the evidence behind their use, and evaluates the management of special subpopulations of posttransplantation patients.
Topics: Disease Management; Graft Rejection; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Liver Transplantation
PubMed: 28364817
DOI: 10.1016/j.cld.2016.12.007 -
Current Opinion in Organ Transplantation Oct 2017Transplantation of allogenic pancreatic islets is a minimally invasive treatment option to control severe hypoglycemia and dependence on exogenous insulin among type 1... (Review)
Review
PURPOSE OF REVIEW
Transplantation of allogenic pancreatic islets is a minimally invasive treatment option to control severe hypoglycemia and dependence on exogenous insulin among type 1 diabetes (T1D) patients. This overview summarizes the current issues and progress in islet transplantation outcomes and research.
RECENT FINDINGS
Several clinical trials from North America and other countries have documented the safety and efficacy of clinical islet transplantation for T1D patients with impaired hypoglycemia awareness. A recently completed phase 3 clinical trial allows centres in the United States to apply for a Food and Drug Administration Biologics License for the procedure. Introduction of anti-inflammatory drugs along with T-cell depleting induction therapy has significantly improved long-term function of transplanted islets. Research into islet biomarkers, immunosuppression, extrahepatic transplant sites and potential alternative beta cell sources is driving further progress.
SUMMARY
Allogeneic islet transplantation has vastly improved over the past two decades. Success in restoration of glycemic control and hypoglycemic awareness after islet transplantation has been further highlighted by clinical trials. However, lack of effective strategies to maintain long-term islet function and insufficient sources of donor tissue still impose limitations to the widespread use of islet transplantation. In the United States, wide adoption of this technology still awaits regulatory approval and, importantly, a financial mechanism to support the use of this technology.
Topics: Diabetes Mellitus, Type 1; Humans; Immunosuppression Therapy; Insulin; Islets of Langerhans Transplantation; Transplantation, Homologous
PubMed: 28692442
DOI: 10.1097/MOT.0000000000000448 -
Handbook of Experimental Pharmacology 2022Benefits of solid organ transplantation in end stage organ diseases are indisputable. Malignancy is a feared complication of solid organ transplantation and is a leading...
Benefits of solid organ transplantation in end stage organ diseases are indisputable. Malignancy is a feared complication of solid organ transplantation and is a leading cause of mortality in patients with organ transplantation. Iatrogenic immunosuppression to prevent graft rejection plays a crucial role in the cancer development in solid organ transplant recipients. Chronic exposure to immunosuppression increases the malignancy burden through deregulation of host immune defense mechanisms and unchecked proliferation of oncogenic viruses and malignancies associated with these viruses. Vigorous screening of candidates undergoing transplant evaluation for malignancies, careful assessment of donors, and vigilant monitoring of transplant recipients are necessary to prevent, detect, and manage this life-threatening complication.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Iatrogenic Disease; Immune Tolerance; Immunosuppression Therapy; Neoplasms; Organ Transplantation
PubMed: 34697663
DOI: 10.1007/164_2021_554 -
Gastroenterology Apr 2016
Topics: Crohn Disease; Female; Humans; Immunosuppression Therapy; Male
PubMed: 26926451
DOI: 10.1053/j.gastro.2016.02.057